Renal Assessment
A patient's urine output totals 80 mL's over the last 24 hours. Which abnormal urine-output term from your module best describes this finding?
Anuria.
Anuria is less than 100 mL in 24 hours. Confirm the measurement, assess the patient, report the finding promptly.
A patient has had several days of vomiting and poor fluid intake. There is a rise in renal values. Which AKI category best fits a cause aside from the kidney itself?
Pre-Renal AKI
Pre-Renal are external factors such as dehydration. Think Before the kidney.
A patient with fever, nausea, flank pain, dysuria, and hematuria is being evaluated for pyelonephritis. What key teaching points should the nurse enforce?
Complete all antibiotics, maintain hydration, empty the bladder (double void), report new fever or chills.
A patient reports fatigue, dizziness, and shortness of breath with activity. The CBC shows low H & H. What BROAD condition should the nurse consider?
Anemia.
Low RBC, Hgb, or both. remember how oxygen is carried through the body!
A patient has new petechiae and easy bruising. The platelet count is decreased.What major risk does this finding signal and what should the nurse teach?
Increased bleeding risk. Avoid activities that can cause injury.
Decreased platelets increases bleeding risk. Petechiae is a clinical manifestation.
A patient reports painful, frequent urination with fever and flank pain. Which additional urine-study findings would support an ascending urinary infection in the kidneys?
Bacteria and hematuria on the Urine analysis, elevated WBC (leukocytosis) and a urine culture with sensitivity to help evaluate the infection.
remember Pyelonephritis: fever, flank pain, dysuria, frequent urination, bacteria and hematuria. Always get culture/sensitivity to help guide treatment.
A patient with AKI has rising potassium and worsening weakness. Which electrolyte complication could be a concern?
Hyperkalemia.
Also note magnesium and phosphorus can cause cramping as well as low calcium levels. If a patient has HYPOcalcemia, this warrants further investigation.
A patient with suspected kidney stones has severe flank pain, nausea, diaphoresis, and visible hematuria. Which test is a KEY DIAGNOSTIC option for the stone?
Stone-survey CT, KUB X-ray, Ultrasound.
Ultrasound for children and PREGNANT patients when you need to AVOID RADIATION.
A patient with iron-deficiency anemia asks how to take their iron supplement to improve absorption. What is the best teaching from the nurse?
Take on an empty stomach with vitamin C/Citris juice. Avoid dairy and tea's.
A patient with hemophilia has swelling and pain in a joint after surgery. Why is this concerning?
Consider hemarthrosis (bleeding into a joint) it can be debilitating and minor injuries and cause significant. blood loss.
Think factor deficiency. Factor 8/9.
A patient with a suspected AKI has NEW edema, hypertension, bounding pulses, and neck-vein distention (JVD). Which problem should the nurse suspect and assess for immediately?
Fluid volume overload.
Manifestations of AKI-associated overload. Remember to assess oxygen and breath sounds, vital sounds, DAILY WEIGHTS, edema, and labs. (Cr, BUN, Na, K....)
A patient with CKD asks why the care team checking blood pressure, daily weights, I & O and labs. How should the nurse respond?
These assessments help track fluid status, cardiovascular effects, renal function, and lab abnormatliites.
A patient being managed for a suspected stone is discharged with instructions to strain all urine. The patient asks why. What is your best response?
Straining the urine will help capture the stone and confirm its past.
Straining urine during a trial of passage can help ensure the stone has passed.
A patient has fatigue, pallor, glossitis, cracks at the corners of the mouth, and spoon-shaped nails. Labs show low serum iron and microcytic RBCs. Which anemia pattern is most likely?
Iron-deficiency anemia.
Low iron, low H & H, microcytic RBC's, glossitis, fissures at the mouth corners, and koilonychia (spoon nails)
A patient being evaluated for leukemia has fatigue, frequent infections, and easy bruising. Which 3 blood-cell problems are associated (Mnemonic ANT)
Anemia, Neutropenia, Thromboctooenia.
A patient's chart documents urine output of 350 ML is 24 hours. The patient also has muscle cramps and worsening edema. What does the urine output indicate, what PHASE of AKI is consistent with this picture?
Oliguria.
Oliguria is less than 400mL in 24 hours. The oliguric phase can include electrolyte abnormalities, edema, cramping, and hypervolemia.
A patient receiving HD has an AV fistula in the arm. A new staff member wants to obtain a blood pressure and draw labs from that arm. What do you do?
Stop them and use another site. Avoid BP and blood draws on the AV fistula/graft arm.
A patient has a family history of polycystic kidney disease. They now report HTN, hematuria, and flank pain. Which disorder does this pattern suggest and what type of condition is it?
Polycystic kidney disease is a genetic disorder that involves clusters of fluid-filled cysts in the renal tubules.
A patient has microcytic anemia, tingling in the feet, visual changes, and altered mental status. Which deficiency should be considered? Why would it be important to NOT overlook it?
Vitamin B12 deficiency. Can cause neurologic manifestations such as peripheral neuropathy and spinal cord degeneration (damage to the myelin sheath and nerve fibers in the spinal cord).
A patient reports painless enlarged lymph nodes, low-grade fevers, night sweats, fatigue, and unexplained weight loss. Which BROAD disorder should the nurse recognize as a concern? What CELL is associated with Hodgkin Lymphoma?
Malignant lymphoma, Hodgkin lymphoma is associated with REED-STERNBERG cells!
painless lymph node swelling, fevers, night sweats, weight loss, fatigue are lymphoma manifestations. Hodgkin Lymphoma is associated with REED STERNBERG cells.
A patient's urine output rises after the the cause of their AKI is corrected. The family states, "the patient is out of the danger zone". What is the best response?
They may be in the diuretic phase but still needs close monitoring for dehydration and fluctuating electrolytes.
"Diuretic Phase" can case dehydration.
During hemodyalysis the patient becomes dizzy, nauseous, and their BP drops. What complication of HD is this most consistent with and what mechanism does this identify with?
HD associated hypotension related to RAPID fluid removal.
Hypotension, cramps, headache, nausea, dizziness, and malaise are linked to hypotension secondary to rapid fluid removal.
A patient develops edema, HTN, decreased urine output, proteinuria, hematuria, and erythrocyte casts after a recent infection. Which renal disorder is most consistent with these findings and what should the nurse trend?
Glomerulonephritis, trend blood pressure, daily weights, I & O, abdominal girth, skin, diet, renal labs.
Acute Glomerulonephritis often follows infection. Complications include AKI, CKD, HTN.
A patient with sickle cell anemia develops severe pains after cold exposure and physical exertion. What triggers may have contributed and which nursing interventions should you anticipate?
Cold temperature and physical activity can trigger a crisis. Oxygen, fluids, and opioids for pain are appropriate management.
A child develops thrombocytopenia after a recent viral infection. Which disorder could explain this?
Immune thrombocytopenia purpura (ITP)
can follow a viral infection or after immunization in children.